Development of consensus guidelines for classification of emergent neonatal transports using a Delphi process.

BACKGROUND

The transport of neonates to tertiary and quaternary neonatal intensive care units occurs frequently in North America, particularly for neonates requiring emergent intervention. The timely stabilization and transfer of a critically ill neonate requiring higher level of care is imperative for optimal clinical outcomes. There is no consensus on the definition of "emergent" related to dispatch of a transport team. However, some utilize a time frame of 30 minutes from referral center request based on illness severity and/or risk. Current definitions of illness severity and/or risk are institution-specific, lacking standardization. The development of consensus-driven guidelines for emergent neonatal transport criteria will provide a framework adaptable across diverse healthcare settings to standardize decision making, resulting in comparable data and outcome measures.

OBJECTIVE

The aim of this project is to develop expert consensus criteria for neonatal emergent interfacility transport.

DESIGN/

METHODS

Following review of available literature and institution-specific guidelines and policies, a subset of neonatologists within the Children's Hospitals Neonatal Consortium (CHNC) Transport Focus Group compiled a proposed list of emergent neonatal criteria. These criteria were divided into three categories: (1) diagnosis, (2) clinical sign, or (3) specialized equipment and/or resources required. Using the Delphi process, CHNC transport leaders voted in two rounds for consensus.

RESULTS

Round 1 of surveys received responses from 31 of 49 (63%) CHNC sites and achieved 100% agreement on criteria, defined as >80% consensus of each criterion. Revisions and additions suggested by participants in Round 1 were incorporated into the Round 2 survey. Round 2 of surveys received responses from 40 of 49 (82%) CHNC sites and again received 100% agreement on criteria.

CONCLUSION(S): All proposed conditions reached consensus for inclusion, falling into one of three major categories. Consensus-derived criteria for emergent neonatal transport will provide a standardized framework for triage, prioritization and resource utilization. Additionally, these guidelines should facilitate national and international benchmarking, improve efficiency and support neonatal outcome-based research across North America.